Encephalopathy after ivermectin treatment in a patient infected with Loa loa and Plasmodium spp

Area of Science:

• Medical Parasitology
• Neuropathology
• Clinical Pharmacology

Background:

• Ivermectin is widely used for parasitic infections, with over 350 million treatments administered.
• Rare severe adverse events, including death, have been reported post-ivermectin treatment.
• These events are frequently associated with high microfilarial loads of Loa loa.

Observation:

• This report details the first autopsy of a fatal encephalopathy following ivermectin administration.
• The patient, a 45-year-old male, developed coma three days post-treatment and died 54 days later.
• Death was likely due to secondary infections exacerbated by malnutrition.

Findings:

• Autopsy revealed high Loa loa microfilaremia, Plasmodium infection, chronic respiratory disease, and cerebral vascular pathology.
• Central nervous system lesions showed similarities to those in fatal cases linked to diethylcarbamazine treatment for Loa loa.
• The case underscores the potential neurotoxic effects of ivermectin in individuals with high Loa loa burdens.

Implications:

• Highlights the critical need for screening for Loa loa before ivermectin treatment in endemic areas.
• Suggests potential mechanisms for ivermectin-induced neurotoxicity in the context of high parasitic loads.
• Informs clinical management and risk assessment for ivermectin use in populations co-infected with Loa loa and Plasmodium.